Cervical Spine MR
Cervical Spine MR
Search Pattern Assist ?Exam
Purpose
2. Assess for developmental hyposegmentation anomalies
3. Assess for evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD)
4. Assess for evidence of concurrent inflammatory arthropathy disorders (ankylosing spondylitis, RA, JRA, psoriatic)
5. MR is the primary diagnostic modality for major ligament injuries and for identifying spinal cord, spinal root contusion/avulsion injuries and dehiscence of the spinal dural sheath with CSF leak (potential for intracranial hypotension)
6. MR can identify sites of ligamentous tears and abnormal synovial joint effusions/extracapsular synovial leaks consistent with capsular injury
7. MR can identify spinal cord injury (contusion, compression, hemorrhage)
8. MR can identify spinal nerve root injuries
9. MR can idenify retropulsed fragments of bone or discs in the spinal canal
10. MR can identify acute fractures
11. MR can distinguish acute from chronic nonunion fracture sites by evidence of or lack of acute edema (especially on STIR)
12. MR can confirm suspected axial loading fractures, especially in the body of C2 and the upper thoracic spine by evidence of medullary edema
13. MR can identify sites of abnormal synovial joint effusions/extracapsular synovial leaks
14. MR can identify sites of disc injury with widened disc space and edema with in disc space(s) (especially on STIR)
15. MR can identify spinal canal or foramen magnum stenosis from vertebral offsets, retropulsed bone/HNP fragments, or chronic underlying causes
16. MR can identify visceral soft tissue & muscle strains, which can explain neck pain in the absence of more significant injury
17. MR can identify tectorial membrane dehiscence and hematomas along the clivus
Prior Study
Cervical spine CT
Findings
Background abnormalities which increase spine vulnerability in trauma
There are levels of restricted motion (hyposegmentation anomalies, operative fusions or acquired autofusions) [Yes/No]
There are abnormal developmental anomalies affecting the C1 ring, C2 pars, and the dens [Yes/No]
There is evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD) [Yes/No]
There is evidence of underlying inflammatory arthropathy possibly increasing or decreasing spine mobility (JRA, RA, psoriatic arthritis, etc.) [Yes/No]
There is underlying bone pathology not related to trauma, but which could have a pathologic fracture [Yes/No]
Injuries to the upper cervical spine (C2 and above) plus the occipital cervical junction
[Yes/No]
Ligamentous injuries
There is abnormal widening of dens tip to basion distance (or avulsion fracture of the clival tip) indicating apical ligament disruption [Yes/No]
There is abnormal malalignment of the cervical canal with the foramen magnum [Yes/No]
There is an abnormal X-lines indicating the dens is abnormally displaced [Yes/No]
The occipital condylar-C1 lateral mass bone margins are not apposed correctly, and there is increased joint fluid indicating capsular injury [Yes/No]
The lateral mass of C1 and the shoulders of C2 facet margins are not apposed correctly, and there is increased joint fluid indicating capsular injury [Yes/No]
Dens position and the width of the atlanto-axial joint space are abnormal and there is increased joint effusion [Yes/No]
There is discernible discontinuity of the high cervical ALL, PLL, spinolaminar, or tectal membrane including its' attachment on the clivus, or of the cruciform ligament (including transverse and apical components) [Yes/No]
Bone fractures and/or other injuries
There is fracture of either occipital condyles; include assessment of an occipital bone fracture extending into the condyle [Yes/No]
There is a fracture of the C1 ring, or there is bilateral translational offset of the lateral masses of C1 relative to C2 (in AP plane) also consistent with a C1 ring fracture (or Jefferson's Fx) even if the fracture line is not discernible [Yes/No]
There is fracture of the dens (3 types) [Yes/No]
There is abnormal cortical rim fracture or medullary buckle or compression in the C2 body indicating fracture, especially at subdental synchondrosis [Yes/No]
There is abnormal appearance of any bone component indicating underlying hypodense nontraumatic pathology. [Yes/No]
There is evidence spinal cord or upper cervical nerve root injury [Yes/No]
There is evidence of spinal canal for foramen magnum stenosis, either related to acute post traumatic injury (fractures or hematomas) or prior underlying conditions. [Yes/No]
There is evidence of post traumatic soft tissue paravertebral (prevertebral, or posterior cervical, or atlanto-occipital space) edema [Yes/No]
Injuries to the cervical spine (C3 and below) plus the cervical-thoracic junction
There is evidence of a cervical bone fracture (either linear, spiral, or trabecular in the cervical region below C2), possibly not evident on CT, which is evident on MR as cortical discontinuity or hyperintensity either within the fracture line or within the medullary portion or a vertebral body [Yes/No]
There is discernible discontinuity of the major ligaments (i.e. transverse, alar, apical, ALL, PLL interspinous), the tectorial membrane nor its attachment on the clivus [Yes/No]
There is disc edema (annular margin of disc itself) and widening of one or more disc spaces inidcating injury to the disc and likely the adjacent major ligaments [Yes/No]
There is ligamentous edema and focal widening within any intra-laminar or intraspinous spaces [Yes/No]
There is focal edema or adjacent hematoma in major ligamentous avulsion sites (anterior or posterior corner fractures) [Yes/No]
There is focal facet misalignment with capsular joint space effusion consistent with articular capsular injury [Yes/No]
There is significant prevertebral or other soft tissue edema or hemorrhage [Yes/No]
There is extraaxial hematoma along the clivus or anywhere within the spinal canal [Yes/No]
There is intraspinal, retropulsed bone fragment or acute HNP [Yes/No]
There is spinal cord injury (compressive deformity, cord edema or cord hermorrhage [Yes/No]
There is foraminal edema, hematoma, extravasation of CSF, or deformity of the root sleeve to suggest root or root sleeve injury [Yes/No]
There is evidence of either carotid or vertebral artery injury or occlusion [Yes/No]
There is evidence of prevertebral, paravertebral, or visceral soft tissue edema or other injury, which confirms traumatic injury or might explain neck pain in the absence of overt vertebral injury. [Yes/No]
Other
No other significant imaging findings are present. [Yes/No]